Haloperidol Versus Chlorpromazine for Treatment of Schizophrenia
C. Leucht; M. Kitzmantel; L. Chua; J. Kane; S. Leucht
Introduction
Chlorpromazine and haloperidol are benchmark antipsychotic drugs which are frequently used as standards in antipsychotic drug trials. For example, in the review on second-generation antipsychotic drugs by Davis et al., haloperidol was by far the most frequently used comparator followed by chlorpromazine. To better define the relative efficacy and safety of both compounds is therefore important for the methodology of randomized controlled trials (RCTs) and for clinical practice where both agents are still frequently used.
Chlorpromazine and haloperidol are benchmark antipsychotic drugs which are frequently used as standards in antipsychotic drug trials. For example, in the review on second-generation antipsychotic drugs by Davis et al., haloperidol was by far the most frequently used comparator followed by chlorpromazine. To better define the relative efficacy and safety of both compounds is therefore important for the methodology of randomized controlled trials (RCTs) and for clinical practice where both agents are still frequently used.
Objectives
To compare the effects of haloperidol and chlorpromazine for people with schizophrenia and schizophrenia-like psychoses.
Search Strategy
We searched the Cochrane Schizophrenia Group's register (August 2006). We searched references of all included studies for further trials. We contacted pharmaceutical companies and authors of relevant trials.
Selection Criteria
We included all RCTs that compared haloperidol with chlorpromazine for people with schizophrenia and/or schizophrenia-like psychoses.
Data Collection and Analysis
Citations and, where possible, abstracts were independently inspected by at least 2 reviewers, and papers ordered,reinspected, and quality assessed. We independently extracted data. For dichotomous data, we calculated the relative risk (RR), 95% confidence interval (CI), and, where appropriate, the number needed to treat (NNT) on an intention-to-treat basis using a random-effects model. For continuous data, we calculated weighted mean differences.
Results
We found 14 relevant studies, mostly of short duration, poorly reported, and conducted in the 1970s (total n = 794 participants). Nine of these compared oral formulations of both compounds and 5 compared intramuscular formulations.
Haloperidol was associated with significantly fewer people leaving the studies early. The efficacy outcome 'no significant improvement' tended to favor haloperidol, but this difference was not statistically significant. Movement disorders were more frequent in the haloperidol groups ('at least one extrapyramidal side-effect', see Figure 1), while chlorpromazine was associated with more frequent hypotension (see Figure 2). Similar trends were found when studies comparing intramuscular formulations and studies comparing oral formulations were analyzed separately.
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To compare the effects of haloperidol and chlorpromazine for people with schizophrenia and schizophrenia-like psychoses.
Search Strategy
We searched the Cochrane Schizophrenia Group's register (August 2006). We searched references of all included studies for further trials. We contacted pharmaceutical companies and authors of relevant trials.
Selection Criteria
We included all RCTs that compared haloperidol with chlorpromazine for people with schizophrenia and/or schizophrenia-like psychoses.
Data Collection and Analysis
Citations and, where possible, abstracts were independently inspected by at least 2 reviewers, and papers ordered,reinspected, and quality assessed. We independently extracted data. For dichotomous data, we calculated the relative risk (RR), 95% confidence interval (CI), and, where appropriate, the number needed to treat (NNT) on an intention-to-treat basis using a random-effects model. For continuous data, we calculated weighted mean differences.
Results
We found 14 relevant studies, mostly of short duration, poorly reported, and conducted in the 1970s (total n = 794 participants). Nine of these compared oral formulations of both compounds and 5 compared intramuscular formulations.
Haloperidol was associated with significantly fewer people leaving the studies early. The efficacy outcome 'no significant improvement' tended to favor haloperidol, but this difference was not statistically significant. Movement disorders were more frequent in the haloperidol groups ('at least one extrapyramidal side-effect', see Figure 1), while chlorpromazine was associated with more frequent hypotension (see Figure 2). Similar trends were found when studies comparing intramuscular formulations and studies comparing oral formulations were analyzed separately.
DOWNLOAD COMPLETE PDF HERE
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